Provider Demographics
NPI:1609479906
Name:FLORES, CARLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 AMBERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1827
Mailing Address - Country:US
Mailing Address - Phone:470-232-8872
Mailing Address - Fax:
Practice Address - Street 1:1190 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4594
Practice Address - Country:US
Practice Address - Phone:770-638-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-030795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist